Doctor in Kivlehan inquest apology
A senior doctor has apologised over a heated conversation he had with the husband of a new mother as her condition deteriorated following an emergency Caesarean section.
Dhara Kivlehan, 29 and originally from India, died in Belfast's Royal Victoria Hospital on September 28 2010 after being airlifted from Sligo hospital where she had given birth a week earlier and suffered a severe strain of pre-eclampsia.
At the inquest into her death, Dr Seamus Crowley, consultant anaesthetist in Sligo, said her ethnicity had no bearing on his assessments of jaundice and liver and kidney dysfunction.
"All I can remember is, I acknowledged to Michael that his wife was from India and her darker complexion would make jaundice more difficult to assess than someone of a paler complexion," Dr Crowley said.
"Unfortunately, it was quite an emotive conversation."
Widower Michael Kivlehan claimed at the opening of the inquest in Carrick-on-Shannon last Monday that Dr Crowley told him it was difficult to tell if his wife was jaundiced from her appearance because she was Indian.
Dr Crowley said his clinical diagnoses of liver issues were based on objective blood tests, not subjective assessments of skin colour and complexion.
The fourth day of the inquest heard there was a 96-hour delay in getting a kidney specialist to assess Mrs Kivlehan and questions over why she was not treated in intensive care immediately after the C-section.
It also heard there were no ICU beds in three Irish hospitals when doctors sought to transfer her.
Lawyers revealed the Health Service Executive (HSE) clinical review report from late 2010 on Mrs Kivlehan's death had called for a database to be set up to constantly monitor the availability of ICU beds nationwide.
There was no evidence it has been set up.
Mrs Kivlehan suffered Hellp syndrome - a severe and rare variant of pre-eclampsia - in the days after the birth of the couple's son Dior.
He turned four last Sunday.
Treatment for pre-eclampsia and the more severe condition Hellp begins with immediate delivery of the baby.
The inquest heard that Dr Crowley questioned whether the new mother was suffering from what medics describe as partial Hellp 24 hours after the delivery. He said he could not explain why she did not undergo renal consultation before she did.
The confrontation between the consultant and Mr Kivlehan took place as the doctor discussed Mrs Kivlehan's case with two other doctors from the obstetrics team, Dr Hind Al Husain and Dr Raouf Sallam.
Dr Crowley said he felt pressured and provoked into asking Mr Kivlehan if he was a doctor after he mentioned spending time in King's College London, where he had been a patient for several months, and raising questions of the need for intensive care treatment.
The inquest heard Mr Kivlehan was worried and tired, and had been up all night prior to demanding answers from the consultant.
Dr Crowley said he uses plain English and avoids medical jargon when speaking to patients and relatives, and did not mean to be patronising.
"I'm sorry to Mr Kivlehan if he was insulted. I was doing what was best for the patient and for the relatives," he said.
The senior doctor said he could not explain why it took four days from the time of admission for a kidney specialist to come and see Mrs Kivlehan.
The hearing has previously heard Mrs Kivlehan was battling five problems including kidney failure, liver dysfunction and issues with her blood, water and urine in the days after the C-section.
The inquest heard HSE guidelines state that a patient suffering with problems affecting two organs should be cared for in intensive care.
A jury of five men and two women are hearing several days of evidence on how his wife died.
Mr Kivlehan and his son were awarded almost one million euro (£780,000) last year after the Health Service Executive (HSE) apologised for shortcomings in her care.
Twelve doctors and seven midwives were involved in Ms Kivlehan's care in Sligo, as well as a number of doctors and nurses in Belfast.
Although Mrs Kivlehan died in Belfast, the inquest was moved to the Republic of Ireland after Attorney General Maire Whelan intervened to ask Belfast coroner Dr John Leckey if he would agree to a change in jurisdiction.
Mrs Kivlehan was suffering from the severe variant of pre-eclampsia called Hellp (Haemolysis, Elevated Liver Enzymes and Low Platelets) in Sligo.
The results of blood tests taken the afternoon she was admitted on September 20 2010, which showed "grossly abnormal liver function and grossly abnormal kidney function", were not followed up by her doctors or reported back by the laboratory for another 12 hours.
Baby Dior was delivered by C-section shortly before 6am the following day.